Pre-existing Conditions

It’s like that old joke: A priest, a minister and a rabbi are discussing the beginning of life. The priest says it begins at conception. The minister says it begins at birth. “And you?” they ask the rabbi. “When do you believe life begins?” He gives a shrug. “When the kids move out and the dog dies.”

Shep Knacker, the protagonist of Lionel Shriver’s latest novel, “So Much for That,” believes his life will begin in earnest only when he quits the rat race and moves to Pemba, an island off the coast of Tanzania whose principal attraction is the low cost of living. Or, as Shep thinks of it, “The third world was running a sale: two lives for the price of one.” Never mind that he built his own company and then sold it for a million dollars. Shep persists in feeling like “an indentured servant.” He wants his liberty, he tells his wife, trying to sell her on the merits of his plan: “I want to buy myself.” Her reply: “But liberty isn’t any different from money, is it?” And, sure enough, the questions this novel raises about human existence prove less ontological than economic. Lest one miss the point, more than half the chapters open with a bank statement, underscoring the impression that plot and character development might be tracked via account balance.

Laying aside for a moment the paradox of a “freedom” wholly dependent on the exchange rate between the Tanzanian shilling and the United States dollar — laying aside, too, the dubious implications of a white American seeking to shed his “slave” status by purchasing land on the cheap and building a home in Africa — can a novel that regards human experience through its relationship to dollars and cents have literary merit? Can it be entertaining, rousing, illuminating?

Well, yes. Look at Austen, Dickens, Thackeray, James, Wharton. Or, more recently, Louis Auchincloss, Tom Wolfe, Jay McInerney. All have made hearty fictional stew out of the ways money both predicates and instigates action. But the approach works best when novelists account for the fact that money is hardly ever (to paraphrase Richard Yates) the real reason characters act — when it’s treated, rather, as a means to stir up weightier social, psychological and philosophical concerns.

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Illustration by Alain Pilon

Shriver, it would seem, has laid the groundwork to do just that. Neither stingy with subplots nor shy about taking on timely, complex issues, she tosses plenty of both into the pot with real daring and brio. Almost as soon as we meet Shep and learn of his determination at last to embark on “the Afterlife” (as he has christened his long-cherished escape fantasy), he’s hit with the news that his wife, Glynis, has a rare cancer, peritoneal mesothelioma, which puts the kibosh on his plans. With oddly triumphant coolness, she informs him that she wishes he wouldn’t go: “I’m afraid I will need your health insurance.”

Co-pays, deductibles, out-of-network providers and lifetime payment caps all ­become part of Shep’s vernacular, first as he navigates his wife’s illness and treatment, then as his octogenarian father breaks his leg and must be moved, at Shep’s expense, into a nursing home. The idiom of illness seeps into the way he views his plight: As his Pemba nest egg dwindles, Shep thinks of himself as “hemorrhaging” money. He sees Glynis’s surgery as “gouging a meaty chunk” from his portfolio, “as if to fiscally mirror the violence inflicted on his wife’s abdomen.” Conversely, his thoughts on mortality conform to the lingo of finance: as far as he’s concerned, the fact that Glynis is dying at age 51 means she is “owed” an “astronomical debt.”

While visiting his father, a retired minister, in the nursing home, Shep wonders aloud about “a limit to how much you should pay to keep any one person alive.” His father parses the matter more finely, asking “what a life is worth, in dollars.” If the scene’s ensuing dialogue is salted with phrases (expenditure cap, cost-­effectiveness, generic ibuprofen) that seem more suited to an editorial on the health care debate than to an intimate exchange between mournful son and ailing paterfamilias, this might reflect Shriver’s journalistic status as a regular contributor to The Guardian of London. There’s nothing wrong with writing a newsworthy novel, but at times these prodigiously researched and exhaustively argued critiques read more like excerpts from a position paper.

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Health care also figures crucially in the story of Shep’s best friend, Jackson, first because his 16-year-old daughter has familial dysautonomia, a congenital degenerative condition requiring frequent medical interventions, and later because Jackson undergoes elective plastic surgery on a “certain” part of his lower anatomy (for more than a third of the book Shriver alludes to this matter in equally coy-yet-transparent language). Said operation, horrifically botched, leads to several reconstructive surgeries, themselves not only “exorbitant” but “disappointing.” These in turn lead to the ruin of Jackson’s marriage, the bankrupting of his family and the . . . well, I won’t give it away, except to say that a “certain” subplot concludes in a scene worthy of a splatter movie. Jane Austen, anyone?

Although this violent swerve into what seemed like a whole different subgenre initially struck me as jarring (so jarring that I wondered whether Shriver’s intentions could be comedic), on reflection it seems not entirely unpresaged. The amount of calcified rage contained in these pages is awesome. Shep is a paragon of passive-aggression, at once disgusted by and perversely proud of the way he absorbs abuse without complaint. Glynis, who begins the book “stiff, uncooperative and inflexible,” undergoes a lamentable kind of emotional growth after the cancer diagnosis: she develops full-blown schadenfreude. Jackson carries around so much excess anger that his acknowledged pastime is ranting. He can keep it up for pages at a time: about “the immigrants,” “arty bohemian types,” “Mugs and Mooches,” parking tickets, taxes, schools and, of course, health care. Jackson’s wife maintains a disturbingly highhanded calm bordering “on insanity.” Shep’s sister is a caricature of shrewish resentment and cunning. His teenage son is so shut-down he puts Shep in mind of hikikomori, youngJapanese who suffer from such acute social withdrawal that they never leave their rooms. And Shep’s boss (Shep now works for the company he sold) is an uninflected ogre.

Shriver, the author of nine previous novels and the winner of Britain’s Orange Prize in 2005 for “We Need to Talk About Kevin,” tackles her multifaceted plot with energy and grit. She can and does hold forth smartly on any number of subjects, both topical and esoteric. The book doesn’t suffer from vapidity or diffidence or dearth of event. What it lacks is a fullness of wisdom about its characters’ potential for growth. If none of the characters are particularly becoming, it may be because none become in any meaningful way over the course of the book. When at last Shep glimpses a solution to his woes, it isn’t the result of an expanded capacity to perceive worth. The trick turns out to be precisely “putting a dollar value on human life” — in other words, the fulfillment of his misguided sense of ­entitlement.

SO MUCH FOR THAT

By Lionel Shriver

436 pp. Harper/HarperCollins Publishers. $25.99

Leah Hager Cohen, a frequent contributor to the Book Review, teaches at the College of the Holy Cross.

A version of this review appears in print on March 14, 2010, on Page BR11 of the Sunday Book Review with the headline: Pre-existing Conditions. Today's Paper|Subscribe